CM with no dialysis experience?

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Specializes in Dialysis, Diabetes Education.

Our current CM is leaving once her CRNP license is approved, so they have been trying to hire a CM for a while now.  Not many options to go with.  They are now considering hiring a nurse from out of state with lots of management experience but no dialysis experience.  The other RN at the clinic and I have concerns.  We need a strong manager that can handle difficult staff, and generally, we can handle most day-to-day issues, so having someone without lots of dialysis knowledge may be OK.  However, that means we have no coverage for vacations/call-offs for a good 6 months to a year.  All the clinics in our area are short-staffed, so no float nurses are available.  And it just seems like a huge learning curve to come into a specialty like this with no idea how a clinic functions. 

In light of this, I am trying to put together a list of questions to discuss with the current leadership.  

Does anyone have any experience with working under a CM without dialysis experience?  Any other questions or concerns I should be raising?

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Specializes in Nephrology, Cardiology, ER, ICU.

I will say that Davita uses a business approach to hiring for management positions - so this often results in the dietician or social worker being the manager, 

I would take a nurse without any dialysis experience over a non-clinical person. 

At my davita unit, there is one RN and two techs for 30 pts. Yep, the RN works 6 days/week open to close and that's been going on for a year!

A the FMC units where I round, staffing remains abysmal as well: 1 RN full time and the DO helps out as well. 

The nursing shortage is real

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Specializes in Geriatrics, Dialysis.

There's a real advantage to hiring a manager that isn't a nurse at all.  Our district has shed managers at an alarming rate this past year, we are down  to two clinics out of 7 having a CM.  Heck I haven't had a CM in about a year in my clinic. The primary reason is simply burnout. So many open shifts, both nurses and PCT's that  managers were covering that they just can't get their work done without putting in massive amounts of work from home or working late hours...all on salary rather than hourly pay.   

If the manager isn't a nurse and therefor isn't qualified to cover those nursing shifts they can actually focus on their own job. Though apparently the answer to that dilemma is hiring a non nursing manager and training that person in as a PCT.  So the oncoming clinic administrator will be responsible for covering any PCT shifts in our clinic that can't get filled but not the nursing shifts.  The new administrator is still in the PCT portion of the training so it's an unknown at this point how well this solution will work. As far as I know that responsibility for covering PCT shifts only applies to our clinic, but who knows if that will change if there's a desperate  PCT need in another clinic. 

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Specializes in Dialysis, Diabetes Education.

Thanks for your feedback!  It sounds like we aren't in too bad of shape considering what everyone else is dealing with!

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How about a manager who is not even clinical staff but a facility administrator (FA)? That is what we have at my clinic.

It is extremely frustrating given that we are chronically understaffed and there is nothing our FA can do but cry for help from other clinics. So, it will be one PCT caring for 8 patients a shift (we have 3 shifts ?) and an RN helping put on and take off patients whilst also carrying out RN duties....not so safe as you can imagine.

Our FA cannot gown up and help on the floor. I really think these companies need to start paying CMs hourly, but I don't think they care as long as they can get by with hiring FAs for cheaper. 

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Specializes in Geriatrics, Dialysis.
Easy Peezie said:

How about a manager who is not even clinical staff but a facility administrator (FA)? That is what we have at my clinic.

It is extremely frustrating given that we are chronically understaffed and there is nothing our FA can do but cry for help from other clinics. So, it will be one PCT caring for 8 patients a shift (we have 3 shifts ?) and an RN helping put on and take off patients whilst also carrying out RN duties....not so safe as you can imagine.

Our FA cannot gown up and help on the floor. I really think these companies need to start paying CMs hourly, but I don't think they care as long as they can get by with hiring FAs for cheaper. 

Same model our clinic went to except the FA is trained as a PCT and will be responsible for covering open PCT  shifts.  That was a job requirement for the position when hired. Our new FA just finished the PCT portion of the training and has already covered multiple PCT shifts in a few clinics. Way to go, let's try to burn out the new FA out by covering PCT's several times a week while the FA training is just getting under way.  I went into this FA/Charge Nurse model of clinic management  thinking it would work great. Now I am having some serious doubts to say the least.

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Specializes in Dialysis Nurse.

We hired a CNA as a CM/FA. Complete fail. Then we hired a car salesman, completely clueless. Then we hired a social worker with no dialysis experienced, ran the place like a resteraunt, forced to quit. Then we hired an experienced dialysis RN. Things improved significantly. 

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Specializes in Dialysis, Diabetes Education.

Wow!  So sorry for all of your situations!  I'm just checking back in and realizing I had more replies.  ?

I ended up leaving in July to take a dialysis manager position for a new program in a rehab hospital.  Most of the time I love it!  I run pt treatments MWF, do my management stuff, some marketing, education, develop curriculum for cross-training rehab nurses to HD, help out with admissions when they need it- so some nice variety.  Doing it all by myself right now, but max census for me is 4, so pretty doable- 2 in the morning, 2 in the afternoon.  I'm in the process of hiring another one or 2 RNs so I can have some coverage in case I'm sick or actually want to take a vacation-and maybe expand to 6 days a week- but I don't have to be worried about getting called to cover other clinics or call-offs.  I work M-F, usually 8-4:30.  If I have 2 shifts of patients I might work a 10-12 hour day, but then I can leave early other days, or just take a day off.  If I run pts afternoon only, then I don't go in until 9 or so.  If I just have 1st shift I come in early, but leave early, too- around 3. There are weeks I don't have any patients at all, so plenty of time to work on all my things.  Other than missing my old patients and coworkers, I don't regret leaving the outpatient clinic at all!

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Hi Duncan,

I worked under a manager that had absolutely no HD experience (and no desire to gain any either)!  It was disastrous !  Unit had high turnover (good nurses who loved their jobs left - average time in 1.0 - 1.5 years in), entrenched culture of bullying new staff (bullies stayed; you know high achievers - they will leave for better environs), no policies in place, unfair staff scheduling (favorites, old timers), unfair PTO, etc...

But the real issues were in running the unit efficiently .  If you don't understand that at a certain time, you must put the wands in the bath/bicarb to get up to conductivity in order to proceed to alarms testing and if you don't - even if you go get your patient -your machine will not be ready to start until several steps completed which takes time.  So the order of 'go' isn't really understood except staff who learn the order to 'keep it going" (get patient while machine is in test).

This is just one example to give - why understanding HD, the machines, the protocols, and all the potential issues and stressors is so integral to being a competent manager who can step in on any issues and know exactly what to do.

I was even redirected as a staff RN from an MD ordered stat tx by a CM once.  Really.  Did she never learn what stat on an order means in nursing school?  Scary.

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